Pub Date : 2025-07-29DOI: 10.1016/j.metop.2025.100382
Salya F. Alfadli , Yazeed S. Alotaibi , Maha J. Aqdi , Latifah A. Almozan , Zahra B. Alzubaidi , Hammad A. Altemani , Shaden D. Almutairi , Hussain A. Alabdullah , Alaa Ahmed Almehmadi , Abdulrahman L. Alanzi , Ahmed Y. Azzam
Introduction
Continuous glucose monitoring (CGM) technologies have been advancing rapidly, but evidence on their comparative effectiveness stills limited to date yet. We conducted a systematic review and meta-analysis to evaluate and investigate the impact of CGM systems on glycemic control in adults with type 1 diabetes.
Methods
We searched electronic literature databases from inception through April 30, 2025, for comparative studies investigating CGM systems with standard monitoring or different CGM technologies in adults with type 1 diabetes. Primary outcomes included HbA1c reduction, time in range (TIR), and hypoglycemia reduction. We performed random-effects meta-analyses, network meta-analysis, and subgroup analyses by baseline HbA1c and intervention duration. Evidence quality was assessed using GRADE methodology.
Results
Twenty-seven studies with total of 2975 participants were included. CGM significantly reduced HbA1c compared to standard monitoring (mean difference: 0.38 %, 95 % CI: 0.49 to −0.27 %). TIR increased by 7.9 % (95 % CI: 5.8–10.0 %), representing 114 additional minutes daily in best range. Real-time CGM showed advantages over intermittently scanned CGM for TIR (+5.63 %, P-value<0.001) and hypoglycemia reduction (−1.28 %, P-value<0.001). Automated closed-loop systems achieved the highest ranking in network meta-analysis (SUCRA = 0.92). Benefits were greater among patients with higher baseline HbA1c (>8.5 %: 0.68 % reduction in HbA1c vs. <7.5 %: 0.24 % reduction in HbA1c, P-value = 0.009).
Conclusions
CGM technologies significantly improve glycemic control in adults with type 1 diabetes, with greater benefits for those with higher baseline HbA1c. Advanced systems demonstrate progressively greater improvements, with automated closed-loop systems showing the strongest evidence of effectiveness. These findings support broader implementation of CGM technologies, with selection tailored to individual patient needs.
{"title":"Effectiveness of continuous glucose monitoring systems on glycemic control in adults with type 1 diabetes: A systematic review and meta-analysis","authors":"Salya F. Alfadli , Yazeed S. Alotaibi , Maha J. Aqdi , Latifah A. Almozan , Zahra B. Alzubaidi , Hammad A. Altemani , Shaden D. Almutairi , Hussain A. Alabdullah , Alaa Ahmed Almehmadi , Abdulrahman L. Alanzi , Ahmed Y. Azzam","doi":"10.1016/j.metop.2025.100382","DOIUrl":"10.1016/j.metop.2025.100382","url":null,"abstract":"<div><h3>Introduction</h3><div>Continuous glucose monitoring (CGM) technologies have been advancing rapidly, but evidence on their comparative effectiveness stills limited to date yet. We conducted a systematic review and meta-analysis to evaluate and investigate the impact of CGM systems on glycemic control in adults with type 1 diabetes.</div></div><div><h3>Methods</h3><div>We searched electronic literature databases from inception through April 30, 2025, for comparative studies investigating CGM systems with standard monitoring or different CGM technologies in adults with type 1 diabetes. Primary outcomes included HbA1c reduction, time in range (TIR), and hypoglycemia reduction. We performed random-effects meta-analyses, network meta-analysis, and subgroup analyses by baseline HbA1c and intervention duration. Evidence quality was assessed using GRADE methodology.</div></div><div><h3>Results</h3><div>Twenty-seven studies with total of 2975 participants were included. CGM significantly reduced HbA1c compared to standard monitoring (mean difference: 0.38 %, 95 % CI: 0.49 to −0.27 %). TIR increased by 7.9 % (95 % CI: 5.8–10.0 %), representing 114 additional minutes daily in best range. Real-time CGM showed advantages over intermittently scanned CGM for TIR (+5.63 %, P-value<0.001) and hypoglycemia reduction (−1.28 %, P-value<0.001). Automated closed-loop systems achieved the highest ranking in network meta-analysis (SUCRA = 0.92). Benefits were greater among patients with higher baseline HbA1c (>8.5 %: 0.68 % reduction in HbA1c vs. <7.5 %: 0.24 % reduction in HbA1c, P-value = 0.009).</div></div><div><h3>Conclusions</h3><div>CGM technologies significantly improve glycemic control in adults with type 1 diabetes, with greater benefits for those with higher baseline HbA1c. Advanced systems demonstrate progressively greater improvements, with automated closed-loop systems showing the strongest evidence of effectiveness. These findings support broader implementation of CGM technologies, with selection tailored to individual patient needs.</div></div>","PeriodicalId":94141,"journal":{"name":"Metabolism open","volume":"27 ","pages":"Article 100382"},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-24DOI: 10.1016/j.metop.2025.100380
Shuwei Tian , Xiaoli Zhang , Jiayong Yu , Juan Cai , Danni Wei , Siqi Li , Pengfei Cai , Wei Song , Suihan Feng , Mengle Shao , Haizhou Li
Adipose tissue, a pivotal metabolic regulator, houses diverse stromal cell populations influencing its dynamic functions. Recent omics studies, including transcriptomics and proteomics, have revealed intricate cellular heterogeneity, yet comprehensive metabolic profiling remains limited. Leveraging fluorescence-activated cell sorting (FACS), we isolated PDGFRα+ DPP4+ and PDGFRα+ DPP4- adipose stromal cells (ASCs) from human orbital adipose tissue (OAT). Integrating gene expression analysis, in vitro adipogenesis assays, and quantitative lipidomics, we characterized their functional and metabolic distinctions. DPP4- ASCs exhibited enhanced adipogenic potential and distinct lipidomic profiles, featuring elevated ceramides and triacylglycerols compared to DPP4+ ASCs. Differential gene expression highlighted metabolic and adipogenic gene signatures reflective of their functional roles in adipose tissue remodeling. Our findings underscore the metabolic heterogeneity within OAT stromal fibroblasts, implicating DPP4- ASCs as potent regulators of adipogenesis and metabolic homeostasis. These insights enhance our understanding of adipose tissue plasticity and may inform therapeutic strategies for conditions like thyroid-associated ophthalmopathy.
{"title":"Quantitative lipidomic analysis reveals distinct metabolic traits between stromal cell subpopulations in human orbital adipose tissue","authors":"Shuwei Tian , Xiaoli Zhang , Jiayong Yu , Juan Cai , Danni Wei , Siqi Li , Pengfei Cai , Wei Song , Suihan Feng , Mengle Shao , Haizhou Li","doi":"10.1016/j.metop.2025.100380","DOIUrl":"10.1016/j.metop.2025.100380","url":null,"abstract":"<div><div>Adipose tissue, a pivotal metabolic regulator, houses diverse stromal cell populations influencing its dynamic functions. Recent omics studies, including transcriptomics and proteomics, have revealed intricate cellular heterogeneity, yet comprehensive metabolic profiling remains limited. Leveraging fluorescence-activated cell sorting (FACS), we isolated PDGFRα+ DPP4+ and PDGFRα+ DPP4- adipose stromal cells (ASCs) from human orbital adipose tissue (OAT). Integrating gene expression analysis, in vitro adipogenesis assays, and quantitative lipidomics, we characterized their functional and metabolic distinctions. DPP4- ASCs exhibited enhanced adipogenic potential and distinct lipidomic profiles, featuring elevated ceramides and triacylglycerols compared to DPP4+ ASCs. Differential gene expression highlighted metabolic and adipogenic gene signatures reflective of their functional roles in adipose tissue remodeling. Our findings underscore the metabolic heterogeneity within OAT stromal fibroblasts, implicating DPP4- ASCs as potent regulators of adipogenesis and metabolic homeostasis. These insights enhance our understanding of adipose tissue plasticity and may inform therapeutic strategies for conditions like thyroid-associated ophthalmopathy.</div></div>","PeriodicalId":94141,"journal":{"name":"Metabolism open","volume":"27 ","pages":"Article 100380"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144714460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-22DOI: 10.1016/j.metop.2025.100381
Ebrahim Abbasi, Iraj Khodadadi
High-fat diet (HFD) poses various health risks, such as obesity, insulin resistance (IR), fatty liver, gut microbiota dysbiosis, cognitive impairment, inflammation, and oxidative stress. HFD can alter gastrointestinal function and structure, resulting in changes of the intestinal mucosa, gastric secretions, intestinal connective tissue, intestinal motility, intestinal metabolomics profiles, and intestinal microbiota. The intestine and its microbiota process nutrients and produce molecules that can regulate insulin action and secretion. Changes in the gut microbiome (dysbiosis) and their products may have long-term effects that are not fully understood. Gut microbiota have long been documented to induce metabolic endotoxemia by releasing lipopolysaccharide, which causes systemic inflammation and insulin resistance (IR). HFD may has direct roles in the development of insulin resistance (IR). HFD can induce dysbiosis by reducing SCFAs and decreasing the activation of free fatty acid receptors (FFARs). Furthermore, HFD can increase the activation of the toll-like receptor (TLR) pathway. Hence, HFD by inducing inflammation, oxidative stress, endotoxemia, and hyperglycemia can increase the risk of IR. Therefore, this review aims to delineate the role of gut microbiota directly or indirectly involved in HFD-induced IR. These findings may clarify valuable preventive and therapeutic targets for countermeasures to IR in people who use the Western diet.
{"title":"High-fat diet may increase the risk of insulin resistance by inducing dysbiosis","authors":"Ebrahim Abbasi, Iraj Khodadadi","doi":"10.1016/j.metop.2025.100381","DOIUrl":"10.1016/j.metop.2025.100381","url":null,"abstract":"<div><div>High-fat diet (HFD) poses various health risks, such as obesity, insulin resistance (IR), fatty liver, gut microbiota dysbiosis, cognitive impairment, inflammation, and oxidative stress. HFD can alter gastrointestinal function and structure, resulting in changes of the intestinal mucosa, gastric secretions, intestinal connective tissue, intestinal motility, intestinal metabolomics profiles, and intestinal microbiota. The intestine and its microbiota process nutrients and produce molecules that can regulate insulin action and secretion. Changes in the gut microbiome (dysbiosis) and their products may have long-term effects that are not fully understood. Gut microbiota have long been documented to induce metabolic endotoxemia by releasing lipopolysaccharide, which causes systemic inflammation and insulin resistance (IR). HFD may has direct roles in the development of insulin resistance (IR). HFD can induce dysbiosis by reducing SCFAs and decreasing the activation of free fatty acid receptors (FFARs). Furthermore, HFD can increase the activation of the toll-like receptor (TLR) pathway. Hence, HFD by inducing inflammation, oxidative stress, endotoxemia, and hyperglycemia can increase the risk of IR. Therefore, this review aims to delineate the role of gut microbiota directly or indirectly involved in HFD-induced IR. These findings may clarify valuable preventive and therapeutic targets for countermeasures to IR in people who use the Western diet.</div></div>","PeriodicalId":94141,"journal":{"name":"Metabolism open","volume":"27 ","pages":"Article 100381"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.metop.2025.100378
Monica Peter , Mithra Balaji , Joe Varghese , Sam Marconi , Yesudhas Sudhakar , Felix Jebasingh , Padmanaban Venkatesan
Introduction
Diabetes in South Asians is driven primarily by impaired beta-cell function. When challenged with a high-calorie diet, this can result in metabolically unfavourable fat accumulation, which in turn worsens beta-cell function, thus constituting a vicious cycle. The investigators hypothesized that short-term mild-to-moderate weight loss induced by calorie restriction could break the cycle, resulting in significant improvements in beta-cell function. The objective of this study, therefore, was to evaluate the efficacy of a short-term weight loss program on body composition and beta-cell function.
Methods
As part of this quasi-experimental pre-post intervention study, 23 overweight normoglycemic participants underwent a low-calorie dietary intervention (∼1500 kcal/day) for a period of 4 weeks. Beta-cell function and insulin sensitivity were measured with a mixed meal challenge test (oral minimal model of glucose) before and after the intervention period. Changes in anthropometric parameters and body composition were also measured. The study was registered prospectively with the Clinical Trials Registry of India - CTRI/2023/04/051807 (https://ctri.nic.in/)
Results
Among the 23 participants in the study, 21 adhered to the intervention. The average weight loss was 3.5 % with an 11 % reduction in trunk fat mass. Beta-cell function, as measured by disposition index, increased by 128 % on average. Robust linear regression analysis showed that beta-cell function improved by 23 % for 1 % weight loss (P = 0.024).
Conclusion
A short-term mild-to-moderate weight loss in overweight normoglycemic subjects effectively improved their beta-cell function.
{"title":"Effect of short-term (4 weeks) low-calorie diet induced weight loss on beta-cell function in overweight normoglycemic subjects: A quasi-experimental pre-post interventional study","authors":"Monica Peter , Mithra Balaji , Joe Varghese , Sam Marconi , Yesudhas Sudhakar , Felix Jebasingh , Padmanaban Venkatesan","doi":"10.1016/j.metop.2025.100378","DOIUrl":"10.1016/j.metop.2025.100378","url":null,"abstract":"<div><h3>Introduction</h3><div>Diabetes in South Asians is driven primarily by impaired beta-cell function. When challenged with a high-calorie diet, this can result in metabolically unfavourable fat accumulation, which in turn worsens beta-cell function, thus constituting a vicious cycle. The investigators hypothesized that short-term mild-to-moderate weight loss induced by calorie restriction could break the cycle, resulting in significant improvements in beta-cell function. The objective of this study, therefore, was to evaluate the efficacy of a short-term weight loss program on body composition and beta-cell function.</div></div><div><h3>Methods</h3><div>As part of this quasi-experimental pre-post intervention study, 23 overweight normoglycemic participants underwent a low-calorie dietary intervention (∼1500 kcal/day) for a period of 4 weeks. Beta-cell function and insulin sensitivity were measured with a mixed meal challenge test (oral minimal model of glucose) before and after the intervention period. Changes in anthropometric parameters and body composition were also measured. The study was registered prospectively with the Clinical Trials Registry of India - CTRI/2023/04/051807 (<span><span>https://ctri.nic.in/</span><svg><path></path></svg></span>)</div></div><div><h3>Results</h3><div>Among the 23 participants in the study, 21 adhered to the intervention. The average weight loss was 3.5 % with an 11 % reduction in trunk fat mass. Beta-cell function, as measured by disposition index, increased by 128 % on average. Robust linear regression analysis showed that beta-cell function improved by 23 % for 1 % weight loss (P = 0.024).</div></div><div><h3>Conclusion</h3><div>A short-term mild-to-moderate weight loss in overweight normoglycemic subjects effectively improved their beta-cell function.</div></div>","PeriodicalId":94141,"journal":{"name":"Metabolism open","volume":"27 ","pages":"Article 100378"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-24DOI: 10.1016/j.metop.2025.100373
Eleni C. Pardali , Christos Cholevas , Odysseas Androutsos , Christina Tsigalou , Dimitrios Poulimeneas , Dimitrios P. Bogdanos , Maria Dalamaga , Dimitrios G. Goulis , Maria G. Grammatikopoulou
Obesity is characterized by the expansion of adipose tissue, contributing to systemic low-grade inflammation, insulin resistance, and widespread disruption of metabolic pathways. These pathophysiological changes are strongly linked to the development of several chronic conditions, including metabolic syndrome, type 2 diabetes, cardiovascular disease, and certain forms of cancer. Metabolomics have emerged as a powerful analytical approach for elucidating obesity-related metabolic disturbances at both the cellular and systemic levels, enabling the identification of specific metabolic signatures associated with disease risk and progression.
This narrative review synthesizes findings from interventional weight loss studies that addressed obesity using various strategies, including dietary modification, physical activity, pharmacotherapy, and bariatric surgery. Focusing on studies employing metabolomic techniques, this review highlights both consistent and divergent patterns in metabolite changes observed following weight loss, particularly in the metabolism of amino acids, lipids, short-chain fatty acids, and other metabolic pathways affected by each intervention. These insights have the potential to inform the development of more personalized and effective therapeutic approaches for obesity, thereby advancing the implementation of precision medicine in obesity management.
{"title":"Interventional approaches to combat obesity: Exploring the metabolomic signature of weight loss trials","authors":"Eleni C. Pardali , Christos Cholevas , Odysseas Androutsos , Christina Tsigalou , Dimitrios Poulimeneas , Dimitrios P. Bogdanos , Maria Dalamaga , Dimitrios G. Goulis , Maria G. Grammatikopoulou","doi":"10.1016/j.metop.2025.100373","DOIUrl":"10.1016/j.metop.2025.100373","url":null,"abstract":"<div><div>Obesity is characterized by the expansion of adipose tissue, contributing to systemic low-grade inflammation, insulin resistance, and widespread disruption of metabolic pathways. These pathophysiological changes are strongly linked to the development of several chronic conditions, including metabolic syndrome, type 2 diabetes, cardiovascular disease, and certain forms of cancer. Metabolomics have emerged as a powerful analytical approach for elucidating obesity-related metabolic disturbances at both the cellular and systemic levels, enabling the identification of specific metabolic signatures associated with disease risk and progression.</div><div>This narrative review synthesizes findings from interventional weight loss studies that addressed obesity using various strategies, including dietary modification, physical activity, pharmacotherapy, and bariatric surgery. Focusing on studies employing metabolomic techniques, this review highlights both consistent and divergent patterns in metabolite changes observed following weight loss, particularly in the metabolism of amino acids, lipids, short-chain fatty acids, and other metabolic pathways affected by each intervention. These insights have the potential to inform the development of more personalized and effective therapeutic approaches for obesity, thereby advancing the implementation of precision medicine in obesity management.</div></div>","PeriodicalId":94141,"journal":{"name":"Metabolism open","volume":"27 ","pages":"Article 100373"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-23DOI: 10.1016/j.metop.2025.100377
Yuriko Hajika, Yuji Kawaguchi
For optimal postprandial glucose (PPG) management, rapid-acting insulin analogs (RAA) should be administered 15 min before a meal; however, this may not be possible for some individuals. Ultra-rapid lispro (URLi) can be administered 0–2 min before or <20 min after a meal, which may improve patient satisfaction and PPG management. In this pilot study, we evaluated changes in quality of life (QOL) and glycemic management among Japanese outpatients with type 2 diabetes mellitus (T2DM) who switched from RAA to URLi. We enrolled 12 outpatients with T2DM and evaluated QOL using the insulin therapy-related (ITR) QOL questionnaire. The primary endpoint was the change in ITR-QOL scores at 12–15 weeks. Endpoints were evaluated using the one-sample Wilcoxon signed rank test or paired t-tests. URLi was associated with a significant increase in ITR-QOL (+15.1 ± 16.1 points, p < 0.01), perception (+7.2 ± 6.9 points, p < 0.01), and status (+7.9 ± 9.5 points, p < 0.05) scores. At 12–15 weeks, the time in range significantly increased (+8.3 ± 9.2, p < 0.05), time above range significantly decreased (−7.7 ± 10.2, p < 0.05), and time below range showed no significant changes. Thus, switching from RAA to URLi significantly improved ITR-QOL questionnaire scores. In summary, URLi is an effective treatment alternative, providing flexible timing, improved glycemic management, and enhanced patient satisfaction.
{"title":"Improved quality of life and glycemic management after switching from conventional rapid-acting insulin to ultra-rapid lispro in patients with diabetes","authors":"Yuriko Hajika, Yuji Kawaguchi","doi":"10.1016/j.metop.2025.100377","DOIUrl":"10.1016/j.metop.2025.100377","url":null,"abstract":"<div><div>For optimal postprandial glucose (PPG) management, rapid-acting insulin analogs (RAA) should be administered 15 min before a meal; however, this may not be possible for some individuals. Ultra-rapid lispro (URLi) can be administered 0–2 min before or <20 min after a meal, which may improve patient satisfaction and PPG management. In this pilot study, we evaluated changes in quality of life (QOL) and glycemic management among Japanese outpatients with type 2 diabetes mellitus (T2DM) who switched from RAA to URLi. We enrolled 12 outpatients with T2DM and evaluated QOL using the insulin therapy-related (ITR) QOL questionnaire. The primary endpoint was the change in ITR-QOL scores at 12–15 weeks. Endpoints were evaluated using the one-sample Wilcoxon signed rank test or paired <em>t</em>-tests. URLi was associated with a significant increase in ITR-QOL (+15.1 ± 16.1 points, <em>p</em> < 0.01), perception (+7.2 ± 6.9 points, <em>p</em> < 0.01), and status (+7.9 ± 9.5 points, <em>p</em> < 0.05) scores. At 12–15 weeks, the time in range significantly increased (+8.3 ± 9.2, <em>p</em> < 0.05), time above range significantly decreased (−7.7 ± 10.2, <em>p</em> < 0.05), and time below range showed no significant changes. Thus, switching from RAA to URLi significantly improved ITR-QOL questionnaire scores. In summary, URLi is an effective treatment alternative, providing flexible timing, improved glycemic management, and enhanced patient satisfaction.</div></div>","PeriodicalId":94141,"journal":{"name":"Metabolism open","volume":"27 ","pages":"Article 100377"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-14DOI: 10.1016/j.metop.2025.100376
Ibrahim Ezuddin M. Almaski , Yazan Jumah Alalwani , Reem Salem Alshammari , Rayyan Mohammed A. Alassiri , Salman Ahmed S. Jathmi , Aishah Mohammed Alhadi , Amal Saleh Alzahrani , Mohammed Abdulwahed Alzahrani , Ahmed Y. Azzam , Tareq A. Maani
Introduction
Enhanced recovery after surgery (ERAS) protocols are evidence-based care improvement processes designed to minimize and reduce the negative physiological consequences of surgery. While previous studies have investigated ERAS in bariatric surgery, none have evaluated which specific components contribute most significantly to improved outcomes.
Methods
We performed a systematic review and meta-analysis following PRISMA 2020 guidelines. Six randomized controlled trials (RCTs) with total of 740 patients comparing ERAS protocols to standard care in bariatric surgery were included. We conducted component-specific meta-regression analysis of 14 individual ERAS elements, dose-response analysis across three implementation levels (low: ≤4 components, medium: 5–8 components, high: ≥9 components), and component clustering to identify synergistic combinations. Meta-regression was used to determine the relative impact of individual components on recovery and safety outcomes.
Results
Six RCTs including a total of 740 patients were included. Patients randomized to ERAS protocols have experienced significant reductions in nausea and vomiting (OR: 0.42, 95 % CI: 0.19–0.95, P-value = 0.040), intraoperative time (MD: 5.40, 95 % CI: 3.05–7.77, P-value<0.001), time to mobilization (MD: 3.78, 95 % CI: 5.46 to −2.10, P-value<0.001), intensive care unit length of stay (MD: 0.70, 95 % CI: 0.13–1.27, P-value = 0.020), total hospital stay (MD: 0.42, 95 % CI: 0.69 to −0.16, P-value = 0.002), and functional hospital stay (MD: 0.60, 95 % CI: 0.98 to −0.22, P-value = 0.002). Component-based analysis demonstrated that early mobilization, anti-emetic protocols, optimized anesthesia, and multimodal analgesia contributed most significantly to improved outcomes. We observed a clear dose-response relationship, with greater benefits in studies implementing more ERAS components.
Conclusion
ERAS protocols significantly improve recovery metrics following bariatric surgery, with certain components demonstrating greater impact than others. Early mobilization and anti-emetic protocols appear particularly beneficial, while the “Complete Recovery Bundle” demonstrates synergistic effects. We recommend a tiered implementation approach, prioritizing high-impact components, especially in resource-limited settings.
{"title":"Component-based approach of enhanced recovery after surgery protocols in bariatric surgery: A systematic review and meta-analysis of randomized controlled trials","authors":"Ibrahim Ezuddin M. Almaski , Yazan Jumah Alalwani , Reem Salem Alshammari , Rayyan Mohammed A. Alassiri , Salman Ahmed S. Jathmi , Aishah Mohammed Alhadi , Amal Saleh Alzahrani , Mohammed Abdulwahed Alzahrani , Ahmed Y. Azzam , Tareq A. Maani","doi":"10.1016/j.metop.2025.100376","DOIUrl":"10.1016/j.metop.2025.100376","url":null,"abstract":"<div><h3>Introduction</h3><div>Enhanced recovery after surgery (ERAS) protocols are evidence-based care improvement processes designed to minimize and reduce the negative physiological consequences of surgery. While previous studies have investigated ERAS in bariatric surgery, none have evaluated which specific components contribute most significantly to improved outcomes.</div></div><div><h3>Methods</h3><div>We performed a systematic review and meta-analysis following PRISMA 2020 guidelines. Six randomized controlled trials (RCTs) with total of 740 patients comparing ERAS protocols to standard care in bariatric surgery were included. We conducted component-specific meta-regression analysis of 14 individual ERAS elements, dose-response analysis across three implementation levels (low: ≤4 components, medium: 5–8 components, high: ≥9 components), and component clustering to identify synergistic combinations. Meta-regression was used to determine the relative impact of individual components on recovery and safety outcomes.</div></div><div><h3>Results</h3><div>Six RCTs including a total of 740 patients were included. Patients randomized to ERAS protocols have experienced significant reductions in nausea and vomiting (OR: 0.42, 95 % CI: 0.19–0.95, P-value = 0.040), intraoperative time (MD: 5.40, 95 % CI: 3.05–7.77, P-value<0.001), time to mobilization (MD: 3.78, 95 % CI: 5.46 to −2.10, P-value<0.001), intensive care unit length of stay (MD: 0.70, 95 % CI: 0.13–1.27, P-value = 0.020), total hospital stay (MD: 0.42, 95 % CI: 0.69 to −0.16, P-value = 0.002), and functional hospital stay (MD: 0.60, 95 % CI: 0.98 to −0.22, P-value = 0.002). Component-based analysis demonstrated that early mobilization, anti-emetic protocols, optimized anesthesia, and multimodal analgesia contributed most significantly to improved outcomes. We observed a clear dose-response relationship, with greater benefits in studies implementing more ERAS components.</div></div><div><h3>Conclusion</h3><div>ERAS protocols significantly improve recovery metrics following bariatric surgery, with certain components demonstrating greater impact than others. Early mobilization and anti-emetic protocols appear particularly beneficial, while the “Complete Recovery Bundle” demonstrates synergistic effects. We recommend a tiered implementation approach, prioritizing high-impact components, especially in resource-limited settings.</div></div>","PeriodicalId":94141,"journal":{"name":"Metabolism open","volume":"27 ","pages":"Article 100376"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steatotic liver disease, characterized by hepatic steatosis, increases the risk of metabolic and cardiovascular diseases. We previously reported that the plasma activity of xanthine oxidoreductase (XOR), primarily expressed in the human liver, is also associated with these diseases. The present study examined whether hepatic steatosis is associated with increased XOR activity.
Methods
This cross-sectional study included 334 participants who underwent health examinations and were not receiving urate-lowering or insulin therapy. Values for controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) obtained with vibration-controlled transient elastography were used to assess hepatic steatosis and fibrosis. Plasma XOR activity was determined with our highly sensitive assay.
Results
Median CAP, LSM, and plasma XOR activity values were 234.0 dB/m, 3.6 kPa, and 27.2 pmol/h/mL, respectively. CAP was correlated with plasma XOR activity (ρ = 0.540, P < 0.001) and subjects with hepatic steatosis (CAP ≥248 dB/m; n = 136) showed higher activity levels than those without (40.8 vs. 21.2 pmol/h/mL, P < 0.001). Multivariable regression analyses, adjusted for confounding factors including aspartate aminotransferase, alanine aminotransferase, adiponectin, and homeostasis model assessment of insulin resistance (IR), indicated associations of CAP and hepatic steatosis with plasma XOR activity (β = 0.163, P < 0.001; β = 0.086, P = 0.037, respectively). These associations remained consistent across subgroups stratified by alcohol consumption. Neither LSM nor hepatic fibrosis (LSM ≥7.9 kPa; n = 4) was associated with plasma XOR activity.
Conclusions
These results suggest that hepatic steatosis increases plasma XOR activity independent of liver enzymes, adiponectin, and IR.
背景：以肝脏脂肪变性为特征的脂肪变性肝病增加了代谢和心血管疾病的风险。我们之前报道了黄嘌呤氧化还原酶（XOR）的血浆活性，主要表达于人类肝脏，也与这些疾病有关。本研究探讨了肝脂肪变性是否与XOR活性增加有关。方法本横断面研究包括334名接受健康检查且未接受降尿酸或胰岛素治疗的参与者。控制衰减参数（CAP）和肝脏刚度测量值（LSM）通过振动控制瞬时弹性成像获得，用于评估肝脏脂肪变性和纤维化。血浆XOR活性用我们的高灵敏度测定法测定。结果CAP、LSM和血浆XOR活性中值分别为234.0 dB/m、3.6 kPa和27.2 pmol/h/mL。CAP与血浆XOR活性相关(ρ = 0.540, P <；0.001)和肝脂肪变性患者(CAP≥248 dB/m；n = 136)的活性水平高于对照组(40.8 vs. 21.2 pmol/h/mL, P <；0.001)。多变量回归分析，调整了混杂因素，包括天冬氨酸转氨酶、丙氨酸转氨酶、脂联素和胰岛素抵抗（IR）的稳态模型评估，表明CAP和肝脂肪变性与血浆XOR活性相关(β = 0.163, P <；0.001;β = 0.086, P = 0.037)。这些关联在按酒精消费分层的亚组中保持一致。无LSM和肝纤维化(LSM≥7.9 kPa；n = 4)与血浆XOR活性相关。结论肝脂肪变性增加血浆XOR活性，不依赖于肝酶、脂联素和IR。
{"title":"Association of hepatic steatosis with increased plasma xanthine oxidoreductase activity: MedCity21 health examination registry","authors":"Masafumi Kurajoh , Shinya Fukumoto , Seigo Akari , Takashi Nakamura , Yuya Miki , Yuki Nagata , Tomoaki Morioka , Katsuhito Mori , Yasuo Imanishi , Toshio Watanabe , Masanori Emoto","doi":"10.1016/j.metop.2025.100374","DOIUrl":"10.1016/j.metop.2025.100374","url":null,"abstract":"<div><h3>Background</h3><div>Steatotic liver disease, characterized by hepatic steatosis, increases the risk of metabolic and cardiovascular diseases. We previously reported that the plasma activity of xanthine oxidoreductase (XOR), primarily expressed in the human liver, is also associated with these diseases. The present study examined whether hepatic steatosis is associated with increased XOR activity.</div></div><div><h3>Methods</h3><div>This cross-sectional study included 334 participants who underwent health examinations and were not receiving urate-lowering or insulin therapy. Values for controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) obtained with vibration-controlled transient elastography were used to assess hepatic steatosis and fibrosis. Plasma XOR activity was determined with our highly sensitive assay.</div></div><div><h3>Results</h3><div>Median CAP, LSM, and plasma XOR activity values were 234.0 dB/m, 3.6 kPa, and 27.2 pmol/h/mL, respectively. CAP was correlated with plasma XOR activity (ρ = 0.540, <em>P</em> < 0.001) and subjects with hepatic steatosis (CAP ≥248 dB/m; n = 136) showed higher activity levels than those without (40.8 vs. 21.2 pmol/h/mL, <em>P</em> < 0.001). Multivariable regression analyses, adjusted for confounding factors including aspartate aminotransferase, alanine aminotransferase, adiponectin, and homeostasis model assessment of insulin resistance (IR), indicated associations of CAP and hepatic steatosis with plasma XOR activity (β = 0.163, <em>P</em> < 0.001; β = 0.086, <em>P</em> = 0.037, respectively). These associations remained consistent across subgroups stratified by alcohol consumption. Neither LSM nor hepatic fibrosis (LSM ≥7.9 kPa; n = 4) was associated with plasma XOR activity.</div></div><div><h3>Conclusions</h3><div>These results suggest that hepatic steatosis increases plasma XOR activity independent of liver enzymes, adiponectin, and IR.</div></div>","PeriodicalId":94141,"journal":{"name":"Metabolism open","volume":"27 ","pages":"Article 100374"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-12DOI: 10.1016/j.metop.2025.100375
Sirwan Khalid Ahmed, Ribwar Arsalan Mohammed
Obesity has emerged as one of the most pressing global public health challenges of the 21st century. Obesity has reached epidemic proportions worldwide, with over 1 billion people classified as obese in 2022, representing 13 % of the global population. Since 1975, obesity rates have tripled, and projections indicate that by 2035, around 1.9 billion adults—approximately 25 % of the world's population—will be affected. Looking further ahead to 2050, it is estimated that 3.80 billion adults, representing more than half of the anticipated global adult population, will be living with overweight or obesity. The increasing burden of obesity is associated with an alarming rise in non-communicable diseases, including type 2 diabetes, cardiovascular diseases, and multiple cancers, collectively contributing to over 5 million deaths annually. Obesity is driven by complex interactions between genetic, behavioral, environmental, and socioeconomic factors, with rapid urbanization and globalization accelerating the consumption of high-calorie diets and sedentary lifestyles. While historically prevalent in high-income nations, obesity rates are now rising most rapidly in low- and middle-income countries (LMICs), with over 70 % of obese individuals living in developing nations. The economic costs of obesity are staggering, with projections estimating a global financial burden of $4.32 trillion per year by 2035, equivalent to 3 % of the global GDP. This article explores the epidemiology, determinants, health implications, and policy responses to obesity, emphasizing the urgent need for multisectoral strategies to mitigate its impact. Public health initiatives, taxation on sugar-sweetened beverages, improved food regulations, and increased physical activity promotion are essential components of evidence-based interventions. Addressing the obesity crisis requires global cooperation to implement sustainable, long-term strategies targeting both prevention and treatment.
{"title":"Obesity: Prevalence, causes, consequences, management, preventive strategies and future research directions","authors":"Sirwan Khalid Ahmed, Ribwar Arsalan Mohammed","doi":"10.1016/j.metop.2025.100375","DOIUrl":"10.1016/j.metop.2025.100375","url":null,"abstract":"<div><div>Obesity has emerged as one of the most pressing global public health challenges of the 21st century. Obesity has reached epidemic proportions worldwide, with over 1 billion people classified as obese in 2022, representing 13 % of the global population. Since 1975, obesity rates have tripled, and projections indicate that by 2035, around 1.9 billion adults—approximately 25 % of the world's population—will be affected. Looking further ahead to 2050, it is estimated that 3.80 billion adults, representing more than half of the anticipated global adult population, will be living with overweight or obesity. The increasing burden of obesity is associated with an alarming rise in non-communicable diseases, including type 2 diabetes, cardiovascular diseases, and multiple cancers, collectively contributing to over 5 million deaths annually. Obesity is driven by complex interactions between genetic, behavioral, environmental, and socioeconomic factors, with rapid urbanization and globalization accelerating the consumption of high-calorie diets and sedentary lifestyles. While historically prevalent in high-income nations, obesity rates are now rising most rapidly in low- and middle-income countries (LMICs), with over 70 % of obese individuals living in developing nations. The economic costs of obesity are staggering, with projections estimating a global financial burden of $4.32 trillion per year by 2035, equivalent to 3 % of the global GDP. This article explores the epidemiology, determinants, health implications, and policy responses to obesity, emphasizing the urgent need for multisectoral strategies to mitigate its impact. Public health initiatives, taxation on sugar-sweetened beverages, improved food regulations, and increased physical activity promotion are essential components of evidence-based interventions. Addressing the obesity crisis requires global cooperation to implement sustainable, long-term strategies targeting both prevention and treatment.</div></div>","PeriodicalId":94141,"journal":{"name":"Metabolism open","volume":"27 ","pages":"Article 100375"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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